ON SOME OF THE APPARENT PECULIARITIES OF PAR- TURITION IN THE NEGRO RACE, WITH REMARKS ON RACE PELVE'' IN GENERAL. JOSEPH TABER JOHNSON, A.M., M.D., Lecturer on Obstetrics the Medical Department Washington, D.C.; in of Georgetown College, late Obstetric Physician to the Freedmen's Hospital; one of the Physicians to St. John's Hospital, etc. , etc. Reprinted from “Journal, op Obstetrics” for May, 1875. NEW YORK : WILLIAM WOOD & CO.. No. 27 GREAT JONES STREET. 1875. ON SOME OF THE APPARENT PECULIARITIES OF PARTURITION IN THE NEGRO RACE, WITH REMARKS ON RACE PELVES IN GENERAL. / Bt JOSEPH TABEB, JOHNSON, A.M., M.D., Lecturer on Obstetrics in the Medical Department of Georgetown College, Washington, D.C.; late Obstetric Physician to the Freedmen’s Hospital; one of the Physicians to St. John’s Hospital, etc., etc. Having attended several hundred negro women in their con- finements, and meeting with surprisingly few preternatural or instrumental cases among them, I have been interested in mak- ing some further investigations upon this subject, and have collected the histories of two thousand negro labors for that purpose. I propose in this paper to institute a comparison be- tween the proportion of “ puerperal accidents,” cases requiring instrumental interference, length of convalescing stage, with the obstetric average of corresponding cases in white women, as given in our text-books upon midwifery ; and to briefly discuss the causes of the immunity of negro women from these puer- peral complications, particularly the anatomical formation of the negro female pelvis, the diameters of the negro foetal head, and the habits of life of those women whose histories are given below. I had collected for comparison two thousand-one hundred labors in negro women; but as the average in medical literature is given as so many in one thousand I shall calculate upon two thousand only as my basis. Five hundred of the cases referred to have occurred in my own practice, and I am indebted to Drs. C. B. Purvis and A. T. Augusta, two busy colored physicians, for the histories of about eight hundred more, while the remainder, or seven hun- dred cases, occurred in the practice of colored midwives, or ” “ grannies as they are called, mostly among the former slaves of the South. Where there exists so large a colored popu- lation as in our city —and it reaches at the present time to upwards of 40,000 —and where that population, as in our case, is mostly very poor, physicians are not called in to attend upon confinements unless emergencies arise requiring greater skill 2 Johnson : Apparent Peculiarities of than is possessed by the ordinary colored midwife. These women have no anatomical or physiological knowledge of the “mechanism of natural labor,” or the science of obstetrics, but they have accumulated a vast deal of experience from the hundreds of cases which are unreservedly entrusted to their care. The statistics of Churchill, so universally adopted by obstet- rical writers, will be used as the standard of comparisons among white women, in this article. Length ofLabor.—Twenty-live of these two thousand labors lasted beyond twenty-four hours. How much longer some of them may have continued I have no reliable facts to show. None of my own live hundred cases lasted a greater time than above stated, and I have no accounts of a single death from prolonged labor. Especial inquiry was made upon this point among the “ grannies.” It is very difficult to bring them to exact facts. They make a distinction between labor and “ hard labor.” .Negro women have frequently told me that their labor began three or even four days ago, but that “ hard labor ” had only lasted an hour or two. This I do not understand as an indication that the os uteri had been three or four days in dilating before expulsive pains came on, but simply that they considered their “ time up,” and the occasional pains in the back and uterus which they experienced, were set down as the beginning of their labor. I have been called to attend a num- ber of women who were said to be in “ hard labor,” and have gone at once with the messenger and found the child kicking and crying in the bed upon my arrival. This also occurs with white women, but so far as my experience and reading goes, not so frequently. The average length of labor in these women, so far as it has been possible to calculate it, was about three hours. Meigs, in his “ Treatise on Obstetrics,” p. 292, says: “ The aver- duration stated at four hours : I ageO of labor has been ' should think it greater. There are many examples of women in labor who are completely delivered in ten minutes from the first perception of the signs of parturition. Very numerous cases occur in which labor is protracted during twenty-four hours, while some of the patients are occupied three, four, and even five days, with continuous efforts to bring the child into the world. I have witnessed one labor of nine days’ duration, and Parturition in the Negro Pace. 3 many from three to five days.” It is altogether probable that Meigs’ experience was confined almost exclusively to white women, and to the better classes of society. I should say that the average among white women in my practice had been at least six hours. The remark Livingston regard to the natives of of Dr. iT} in O South Africa considering parturition to be an act of nature and not of disease, applies almost as forcibly to the negro women of the United States. There is a noticeable difference, however, in the manner and bearing of our dashing mulattoes and quadroons. The multiparous negress will, as a rule, cheerfully bend all her energies toward the accomplishment of the end, which she knows full well has to be accomplished, and, believing it to be a natural process which will do her no harm, hastens through it as rapidly as her powers will allow. With the mulattoes this is not so much the case. They appear to have less courage or endurance than the pure negroes, and so far as my experience goes, this lack is a notable feature in most of their diseases. average of hreech Presentations , etc.—The presentations stated by Leishman is “about 1 in every 45 mature births;” Churchill says about one in every 59f ; Collins about one in every 68; Meadows one in every 72-| cases. It has been impossible to get reliable details from the colored “ grannies ” in regard to the variety of presentations, i.e., whether they were feet, knees, or breech. I find,'however, what appear to have been breech presentations occurring 4 times in the practice of these “ grannies.” I have met with 2 cases, and have reports of 4 more. In all 10 cases, making this presenta- tion occur in these 2,000 labors once in every 200 cases. There are no accounts of shoulder or fare presentations. One of my cases occurred in the Freedraeu’s Hospital, and pre- sented one foot, one hand, and the funis, with the head so crowded down by a powerfully acting uterus as to render ver- sion very difficult. The child in this case was still-born. The facts in my possession do not enable me to give positive state- ments that the aboveratio is correct, but I feel abundantly war- ranted in the belief, that the head presents with greater uni- formity among the negro women of the United States than 4 Johnson : Apparent Peculiarities of among white women as recorded in our text-books upon mid- wifery. Churchill, from an analysis of 466,424 labors, found that twins occurred once in every eighty-three cases. In my analysis of 2,000 labors in negro women, I find that twins were delivered once in every four hundred cases. Triplets occurred in my wards at the Freed men’s Hospital, once. The Period of Convalescence in negro women is proverbially short and uncomplicated. My own experience and the state- ments of physicians and colored midwives who have had abundant opportunities for gaining information upon this point, confirm this proverb, the letters of occasional medical or his- torical writers travelling in negro countries to the contrary notwithstanding. It has been impossible to confine patients to their beds for “ nine days.” They have frequently been dressed and about their rooms on the third and fourth days after confinement. They had pursued this course in previous labors, and had suf- fered no harm, and thought they gained strength faster than when lying in bed ; and it is rare that I am called upon to treat any disease which originated during the puerperal month. Prolapsus uteri I have found to be rather common in negro women, but have been in the habit of attributing it to their modes of life, especially to the lifting and carrying heavy bur- dens, many of them upon their heads and during menstrua- tion. How far the neglect of proper management after con- finement may be causative of uterine displacements, I cannot say. From a knowledge, however, of the time required for the completion of the process of sub-involution, it would seem that this must be its chief cause ; but so far as my knowledge and experience go, this has not seemed to be the case. These women invariably nurse their children from healthy •and bountiful breasts. They are unwilling frequently to wean them at the end of nine months or a year. I have seen several negro women nursing children over two years of age, and some ?over three.